Cohen S I, Frank H A
Chest. 1982 Jan;81(1):51-4. doi: 10.1378/chest.81.1.51.
Loss or reversal of the normal sequence of atrioventricular contraction, such as occurs during ventricular pacing, can significantly reduce cardiac output. Opinions vary regarding the size of the pacemaker population that might benefit from preservation of active atrial transport during cardiac pacing. An assessment of 260 consecutive patients who underwent implantation of a permanent transvenous pacemakers by the authors between 1970 and 1979 revealed 19 patients who had clinical symptoms or hypotension when active atrial transport was lost. Thirteen patients were symptomatic with syncope, dizziness, shock, heart failure or cough; six were asymptomatic but had systolic blood pressures lowered to the 80-100 mm Hg range. In all instances but one, attempts were made to restore atrial transport by one or more of the following methods: replacement of the pulse generator with a slower, single rate generator to minimize pacer competition with the normal sinus mechanism; slowing the rate of a programmable unit; implantation of an atrial pacing system; implantation of an atrioventricular sequential pacemaker system. Restoration of the normal sequence of chamber activation by any of these methods eliminated the symptoms and stabilized arterial blood pressure. We conclude that preservation of active atrial transport was clinically important in 7.3 percent of our heterogeneous permanent pacemaker population.
房室收缩正常顺序的丧失或逆转，如在心室起搏期间发生的情况，可显著降低心输出量。关于在心脏起搏期间可能从保留心房主动运输中受益的起搏器人群规模，意见不一。作者对1970年至1979年间连续260例行永久性经静脉起搏器植入术的患者进行评估，发现19例患者在心房主动运输丧失时出现临床症状或低血压。13例患者出现晕厥、头晕、休克、心力衰竭或咳嗽等症状；6例无症状，但收缩压降至80 - 100 mmHg范围。除1例外，在所有情况下，均尝试通过以下一种或多种方法恢复心房运输：用较慢的单速率发生器更换脉冲发生器，以尽量减少起搏器与正常窦性机制的竞争；减慢可编程单元的速率；植入心房起搏系统；植入房室顺序起搏器系统。通过这些方法中的任何一种恢复心室激活的正常顺序，均可消除症状并稳定动脉血压。我们得出结论，在我们这一异质性永久性起搏器人群中，保留心房主动运输在7.3%的患者中具有临床重要性。
